3DSlicer软件弥散张量成像纤维束追踪技术在听神经瘤手术中的应用  

Application of diffusion tensor imaging tractography technology to microsurgery for acoustic neuroma

作　　者：杨吉鹏[1] 邱翔[1] 刘英辉 李晓瞳 李琛[1] 李朝晖[1] 胡红超[1] 陈晓雷[4] 孙晓枫[1] Yang Jipeng;Qiu Xiang;Liu Yinghui;Li Xiaotong;Li Chen;Li Zhaohui;Hu Hongchao;Chen Xiaolei;Sun Xiaofeng(Department of Neurosurgery,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院神经外科,石家庄050000 [2]河北医科大学第二医院医学影像科,石家庄050000 [3]曲阳县人民医院 [4]中国人民解放军总医院

出　　处：《脑与神经疾病杂志》2021年第6期346-351,共6页Journal of Brain and Nervous Diseases

基　　金：河北省重点研发计划项目民生科技专项(20377703D);河北省科技厅-河北医科大学“厅校会商基金-科技创新”项目(2020TXJCO3)。

摘　　要：目的评价3DSlicer软件进行弥散张量成像纤维束追踪在听神经瘤术中的应用价值,探索一种有效的辅助听神经瘤术中保护面神经功能的方法。方法随机选取2020年3月至2020年8月河北医科大学神经外科收治的听神经瘤患者43例按患者志愿分为观察组(21例)与对照组(22例),观察组患者术前完善FIESTA、DTI等影像学检查,并利用3DSlicer软件重建肿瘤与面神经纤维并预判肿瘤与面神经的位置关系,术中联合神经电生理检测辅助听神经瘤手术切除,并记录术中面神经的实际位置;对照组仅利用神经电生理检测辅助定位面神经走行来指导手术完成。计算术前重建面神经位置与术中实际情况的符合率;比较两组患者术后1 w面神经功能(House-Brackmann标准)与听力保留率的差异。结果利用3DSlicer软件弥散张量成像纤维束追踪技术为观察组21例听神经患者重建面神经成功20例,重建失败1例;20例患者中17例术前重建的面神经位置与其术中实际位置一致,符合率为85%;观察组患者术后1 w面神经功能明显优于对照组(P<0.05),听力保留率也高于对照组(P<0.05)。结论应用3DSlicer软件弥散张量成像纤维束追踪技术可有效辅助听神经瘤术中面神经的精准定位,有利于术中寻找与保护面神经,提高听神经瘤患者术后面神经的功能保留率和听力保留率。Objective To evaluate the application efficiency of diffusion tensor imaging(DTI)tractography using 3DSlicer software in acoustic neuroma surgery,and to explore an effective assistant method to protect function of facial nerve during acoustic neuroma surgery.Methods 43 patients with acoustic neuroma admitted in our department from March 2020 to August 2020 were randomly selected and divided into observation group(21 cases)and control group(22 cases).The imaging examination of patients in observation group,such as DTI and FIESTA,were completed preoperatively.After reconstruction of tumors and facial nerve in observation group,the location relationship between tumor and facial nerve was predicted.The actual location of facial nerve was recorded during surgery.The tumors of patients in observation group were removed with combination of diffusion tensor imaging tractography and neurotic electrophysiology.The surgeries were completed only based on the assist of neurotic electrophysiology in control group.The accuracy rate of facial nerves reconstructed preoperatively was obtained.The difference of retention rate of facial nerve function(House-Brackmann)and hearing 1 week after operation was compared between the two groups.Results In the observation group,the reconstruction of facial nerve was achieved successfully in 20 patients and failed in 1 case.In 17 of the 20 cases above mentioned,the location of the reconstructed facial nerve was consistent with the intraoperative actual location with an accuracy rate of 85%.The facial nerve function of the observation group was significantly better than that of the control group(P<0.05)and the hearing retention rate was also higher than that of the control group(P<0.05).Conclusion The 3DSlicer diffusion tensor imaging tractography technology can effectively assist the localization of facial nerve for the resection of acoustic neuroma.This technology that was highly helpful for finding and protecting facial nerve during surgery could improve the retention rates of facial nerve

关 键 词：听神经瘤 显微手术 面神经 

分 类 号：R764.4[医药卫生—耳鼻咽喉科]